AUA 2018 Prostate Cancer

San Francisco, CA USA (UroToday.com) The resolution provided by prostate mpMRI has increasingly been used in contemporary studies to improve on prediction of adverse pathologic features after radical prostatectomy and to better characterize index lesions that may be candidates for focal therapy. In today’s session, there have been several of these types of studies presented. Previous literature has assessed the mpMRI ‘tumor contact length’ and prognostication for predicting extracapsular extension. Among 183 patients with biopsy proven prostate cancer, 56% of patient had extraprostatic disease, with a tumor contact length of ≥14 mm being highly predictive for peripheral zone tumor extraprostatic extension (OR 4.9, 95%CI 2.3-10.2) [1]. However, the impact of tumor contact length in other regions of the prostate, aside from the peripheral zone, are less clearly defined. Dr. Matsumoto and colleagues from Tokyo presented results of their study assessing mpMRI tumor contact length arising from tumors of zonal origin (anterior or posterior tumor) and risk of extraprostatic extension.
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San Francisco, CA (UroToday.com) Based on different hospital jurisdiction policies and cultural norms, globally there is a wide variation of post-operative care for patients undergoing radical prostatectomy. For instance, in Italy, some centers will wait until the patient is ready to have their catheter removed prior to discharge since many patients travel from great distances to have their operation. Alternatively, patients in the United States and Canada undergoing robotic radical prostatectomy are frequently discharged on the first post-operative day with their Foley catheter in situ.
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San Francisco, CA (UroToday.com) The impact of black race leading to higher risk and more aggressive disease, as well as inferior outcomes compared to Caucasian men is well-established among patients with prostate cancer. Hypotheses for these racial disparities include, but are not limited to socioeconomic disparities, poor access to care, and biologic differences in disease.

San Francisco, CA (UroToday.com) Over the past two decades, there has been increasing uptake and adherence to active surveillance protocols for patients with very-low or low risk prostate cancer [1-3]. However, the uptake and eligibility of African Americans (AA) monitored on active surveillance is less clear as studies have suggested that these patients may be at increased risk of PCa progression compared to Caucasians.
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AUA 2018: Predictors of Organ Confined Disease in High and Very High-Risk Prostate Cancer Patients Staged with mpMRI

San Francisco, CA (UroToday.com) The reasons are likely multifactorial, but urologists are increasingly operating on high-risk patients for prostate cancer. These reasons likely include decreased screening for prostate cancer leading to a delayed presentation [1], and increased uptake of active surveillance [2-3]. Furthermore, with the recent randomized clinical trials demonstrating a survival benefit for men presenting with N1 and/or M1 disease treated with either docetaxel or abiraterone acetate, the treatment paradigm continues to change and evolve.
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San Francisco, CA USA (UroToday.com) Patients that have seminal vesicle involvement at the time of radical prostatectomy (pT3b), represent a subset of patients with the highest risk of biochemical recurrence and development of subsequent metastasis for patients undergoing radical prostatectomy. In addition to Gleason ≥8 disease, pT3b is one of the strongest predictors for poor outcomes, across many published series. However, historically, identifying seminal vesicle invasion prior to radical prostatectomy has been a diagnostic challenge.
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